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Montesi L, Ramírez-Rojas MG, Elizarrarás-Rivas J. Health Care Delays and Social Suffering Among Indigenous People with Diabetic Foot Complications in Mexico. Med Anthropol 2024; 43:411-427. [PMID: 38865593 DOI: 10.1080/01459740.2024.2364241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Diabetic foot (DF) is a leading cause of nontraumatic lower-extremity amputations, premature death, and a sign of social inequality in diabetes treatment. In Mexico, the incidence of DF is on the rise yet little is known about its impact among indigenous people, a disadvantaged group. Based on ethnographic research conducted in Oaxaca and analysis of institutional health-data, in this article we show the health care delays that rural indigenous people face when dealing with DF. Indigenous people's uncertainty regarding their right to health and the structural barriers to medical care favor DF complications, a phenomenon that should be read as social suffering. Since health data concerning indigenous health care service users is patchy and imprecise, indigenous people's social suffering is invisibilized. This omission or partiality in the official records limits public health decision-making and undermines the human rights of the population.
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Affiliation(s)
| | | | - Jesús Elizarrarás-Rivas
- Health Research Coordination, Mexican Institute of Social Security (IMSS), Oaxaca, Mexico
- Universidad Autónoma Benito Juárez de Oaxaca (UABJO), Oaxaca, Mexico
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Mafusi LG, Egenasi CK, Steinberg WJ, Benedict MO, Habib T, Harmse M, Van Rooyen C. Knowledge, attitudes and practices on diabetic foot care among nurses in Kimberley, South Africa. S Afr Fam Pract (2004) 2024; 66:e1-e10. [PMID: 38949451 PMCID: PMC11219695 DOI: 10.4102/safp.v66i1.5935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND Diabetic foot is a dangerous complication of diabetes and can lead to high morbidity and mortality. As essential team members of the healthcare system, nurses play an important role in diabetic foot management and are indispensable in patients' education to prevent diabetic foot. The study assessed nurses' knowledge, attitudes and practices regarding diabetic foot care in Sol Plaatje primary health care centres in the Northern Cape: Sol Plaatje's 14 district municipality clinics, Kimberley, Northern Cape. METHODS This was a descriptive cross-sectional analytical study. A questionnaire assessed nurses' knowledge, practices and attitudes towards diabetic foot care in the above setting. RESULTS A total of 128 professionals, enrolled and auxiliary nurses who are providing primary care to patients within the 14 clinics in the Sol-Plaatje sub-district were recruited for the study. Hundred and five participants completed the self-administered questionnaires. The majority (95%) were females and 58.1% knew that South African Diabetic Foot Guidelines existed, while 57.7% had read them. About 57% did not know about the 60-s diabetic foot screening tool, and 67% did not know the 10 g monofilament test. Approximately 29.8% had never attended a class on diabetic foot care and 85.6% required training on diabetic foot care. CONCLUSION This study revealed that the majority of nurses working in the Sol-Plaatje sub-district primary health care centres are knowledgeable of the diabetic foot guidelines for primary care. However, there is a need for ongoing education on diabetic foot care.Contribution: The study results will help improve nurses' awareness of the importance of diabetic foot care.
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Affiliation(s)
- Labala G Mafusi
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa; and, Department of Family Medicine, Robert Mangaliso Sobukwe Hospital, Kimberley.
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Prins H, Donia S, Rockall S, Hektner J, Hawes S, Laskin JJ, Chernesky J, Noonan VK. Implementing Lived Experience Workshops in Regional Areas of British Columbia to Enhance Clinicians' Confidence in Spinal Cord Injury Care: An Evaluation. Healthcare (Basel) 2024; 12:731. [PMID: 38610153 PMCID: PMC11011360 DOI: 10.3390/healthcare12070731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1-14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11-14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians' knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians' understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC.
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Affiliation(s)
- Hannah Prins
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Scott Donia
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Shannon Rockall
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - James Hektner
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Spring Hawes
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - James J. Laskin
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - John Chernesky
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Vancouver, BC V5Z 1M9, Canada; (H.P.); (S.D.); (S.R.); (J.H.); (S.H.); (J.J.L.); (J.C.)
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Neves SR, Dias Moreira A, Bandeira FF, Horta TG, Pagano AS, Reis JS, Soares AN. Tradução, adaptação cultural e validação do Instrumento de Autoavaliação em Diabetes. REME: REVISTA MINEIRA DE ENFERMAGEM 2023. [DOI: 10.35699/2316-9389.2023.38826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
Objetivo: realizar a tradução, adaptação cultural e validação do instrumento “Instrumento de Autoavaliação em Diabetes” para aplicação no contexto brasileiro. Métodos: estudo metodológico realizado com 132 profissionais, entre os anos de 2016 e 2018, em seis etapas: 1- Tradução inicial; 2- Síntese da tradução; 3- Retrotradução (back-translation); 4- Avaliação pelo comitê de juízes; 5- Adequação cultural (pré-teste); 6- Reprodutibilidade. Houve participação de profissionais de equipes multiprofissionais envolvidas no tratamento do diabetes, por meio da plataforma e-surv. Resultados: entre os participantes, predominaram o sexo feminino (73,5%), profissionais com especialização (pós-graduação Lato Sensu) (51,5%) e com experiência na assistência a pessoas com diabetes (84,4%). O Índice de Validade de Conteúdo (IVC) foi satisfatório (média de 0,850). O instrumento apresentou boa consistência interna (Alfa de Cronbach=0,878). A análise de confiabilidade do instrumento, realizada pelo cálculo do coeficiente de correlação intraclasse (CCI), indicou concordância adequada em todas as medidas, 0,878 (IC 95%: 0,864 – 0,891), com Kappa Ponderado médio de 0,714 e índices acima de 0,60 em 85% os itens, mostrando boa concordância teste e reteste. Conclusão: a versão traduzida e adaptada culturalmente do Instrumento de Autoavaliação em Diabetes apresentou boa confiabilidade, aceitabilidade e estabilidade temporal satisfatórias conforme os parâmetros internacionais, podendo ser utilizada para autoavaliação em diabetes pelos profissionais da saúde.
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Zhao N, Xu J, Zhou Q, Hu J, Luo W, Li X, Ye Y, Han H, Dai W, Chen Q. Screening behaviors for diabetic foot risk and their influencing factors among general practitioners: a cross-sectional study in Changsha, China. BMC PRIMARY CARE 2023; 24:68. [PMID: 36907863 PMCID: PMC10009976 DOI: 10.1186/s12875-023-02027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Diabetic foot is a serious complication of diabetes with a high disability and mortality rate, which can be prevented by early screening. General practitioners play an essential role in diabetic foot risk screening, yet the screening behaviors of general practitioners have rarely been studied in primary care settings. This study aimed to investigate foot risk screening behaviors and analyze their influencing factors among general practitioners. METHODS A cross-sectional study was conducted among 844 general practitioners from 78 community health centers in Changsha, China. A self-designed and validated questionnaire was used to assess the general practitioner's cognition, attitude, and behaviors on performing diabetic foot risk screening. Multivariate linear regression was conducted to investigate the influencing factors of risk screening behaviors. RESULTS The average score of diabetic foot risk screening behaviors among the general practitioners was 61.53 ± 14.69, and 271 (32.1%) always or frequently performed foot risk screening for diabetic patients. Higher training frequency (β = 3.197, p < 0.001), higher screening cognition (β = 2.947, p < 0.001), and more positive screening attitude (β = 4.564, p < 0.001) were associated with more diabetic foot risk screening behaviors, while limited time and energy (β=-5.184, p < 0.001) and lack of screening tools (β=-6.226, p < 0.001) were associated with fewer diabetic foot screening behaviors. CONCLUSION The score of risk screening behaviors for the diabetic foot of general practitioners in Changsha was at a medium level. General practitioners' diabetic foot risk screening behaviors may be improved through strengthening training on relevant guidelines and evidence-based screening techniques, improving cognition and attitude towards foot risk screening among general practitioners, provision of more general practitioners or nurse practitioners, and user-friendly screening tools.
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Affiliation(s)
- Nan Zhao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Department of Nursing, The Second Affiliated Hospital of Xi'an Jiaotong University, 710004, Xi'an, Shaanxi Province, China
| | - Jingcan Xu
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China.
| | - Qiuhong Zhou
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China.
| | - Juanyi Hu
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
| | - Wenjing Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
| | - Xinyi Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
| | - Ying Ye
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
| | - Huiwu Han
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Weiwei Dai
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, 410008, Changsha, China
- Department of Stoma Wound Care Center, Xiangya Hospital, Central South University, 410008, Changsha, China
| | - Qirong Chen
- Xiangya School of Nursing, Central South University, 410013, Changsha, China
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Aalaa M, Amini MR, Delavari S, Mohajeri Tehrani MR, Adibi H, Shahbazi S, Shayeganmehr Z, Larijani B, Mehrdad N, Sanjari M. Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers. Diabetes Metab Syndr 2022; 16:102543. [PMID: 35753291 DOI: 10.1016/j.dsx.2022.102543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Prevention and management of diabetic foot ulcer have essential effects on the quality of life of patients. Accordingly training the care providers can play an essential role in reducing complications foot ulcers and lead to an increase in the effectiveness and efficiency of patient health cares. We conducted a study to survey the impact of the diabetic foot workshop on the knowledge of nurses and physicians about diagnosis and managing diabetic foot. METHODS The present study is a quasi-experimental which compare the knowledge of non-randomized group of nurses and physicians about diabetic foot care. The leaning objectives, agenda, contents and evaluation methods of the diabetic foot care workshop was designed by a multidisciplinary team members in form of 2 days workshop. Each topic of the workshop presented theoretically and practically using educational cases and real patient with diabetic foot ulcer. A valid and reliable questionnaire with 20 Multiple Choice Questions used for the evaluation of workshopin form of the pretest and posttest. RESULTS In this study, 396 registered nurses and physicians participates in the diabetic foot workshop series. The results of this study showed that this increase in the level of knowledge was meaningful after the educational intervention since the mean of the posttest score increased more than 20% comparing with pretest. CONCLUSION The promotion of knowledge of health care providers as shown in the study may almost be due to training by real patient, team-working, and using educational movies for the education of diabetic foot diagnosis, management and rehabilitation.
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Affiliation(s)
- Maryam Aalaa
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Reza Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Mohammad Reza Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hossein Adibi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Samimeh Shahbazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zahra Shayeganmehr
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Neda Mehrdad
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Isa D, Pace D. Is ethnicity an appropriate measure of health care marginalization? A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in Aboriginal populations. Can J Surg 2021; 64:E476-E483. [PMID: 34580076 PMCID: PMC8526134 DOI: 10.1503/cjs.004619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 01/13/2023] Open
Abstract
Background Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. Methods We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies – of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). Results Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04–3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. Conclusion Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.
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Affiliation(s)
- David Isa
- From the Masters in Global Surgical Care Program, Branch of International Surgery, University of British Columbia, Vancouver, BC (Isa); and the Department of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld. (Isa, Pace)
| | - David Pace
- From the Masters in Global Surgical Care Program, Branch of International Surgery, University of British Columbia, Vancouver, BC (Isa); and the Department of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Nfld. (Isa, Pace)
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Bondi ME, Rahim SSSA, Avoi R, Hayati F, Ahmedy F, Omar A, Jeffree MS, Musleh AS. Knowledge, Attitude and Practice on Diabetic Wound Care Management among Healthcare Professionals and Impact from A Short Course Training in Sabah, Borneo. Medeni Med J 2020; 35:188-194. [PMID: 33110670 PMCID: PMC7584266 DOI: 10.5222/mmj.2020.02929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective Healthcare professionals with an advanced level of knowledge and skills on diabetic wound care management are needed to effectively manage complex wounds. This study aimed to determine the effects of an educational intervention to enhance the management of wound care among healthcare professionals. Method This study was part of a quasi-experimental pre-post research design where 82 healthcare professionals were recruited and assigned to intervention and control groups. The participants in the intervention group attended two days of educational intervention training on diabetic wound care management, while there was no intervention in the control group. A questionnaire on knowledge, attitude, and practice was applied before and one-month post-intervention to both groups. Results Pre-test resulted in a low level of knowledge 72.1% and 74.4%, negative level of attitude 67.4% and 66.7%, and a moderate level of practice 79.1% and 76.9% in both intervention and control groups respectively. Post-test resulted in increasing levels of knowledge (76.7%), positive attitude (100%), and practice (76.7%) in the intervention group. At the same time, there was no significant change in the control group. Repeated Measure ANOVA for within-subject and between-subject effects resulted in a statistically significant p-value of 0.001 for knowledge, attitude, and practice after the educational intervention. Conclusion Health professionals have only a moderate level of knowledge on diabetic wound care management. It is important to improve this level by specific trainings and by using a good training module.
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Affiliation(s)
- Melvin Ebin Bondi
- Putatan Health Clinic, Department of Primary Health Care, Putatan, Sabah, Malaysia
| | | | - Richard Avoi
- University of Malaysia Sabah, Department of Community and Family Medicine, Kota Kinabalu, Sabah, Malaysia
| | - Firdaus Hayati
- University of Malaysia Sabah, Department of Surgery, Kota Kinabalu, Sabah, Malaysia
| | - Fatimah Ahmedy
- University of Malaysia Sabah, Department of Medical Education, Kota Kinabalu, Sabah, Malaysia
| | - Azizan Omar
- University of Malaysia Sabah, Department of Community and Family Medicine, Kota Kinabalu, Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- University of Malaysia Sabah, Department of Community and Family Medicine, Kota Kinabalu, Sabah, Malaysia
| | - Awang Setia Musleh
- University of Malaysia Sabah, Department of Community and Family Medicine, Kota Kinabalu, Sabah, Malaysia
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Bus SA, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Sacco ICN, van Netten JJ. Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 2020; 36 Suppl 1:e3269. [PMID: 32176451 DOI: 10.1002/dmrr.3269] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the prevention of foot ulceration in persons with diabetes and updates the 2015 IWGDF prevention guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. We recommend to screen a person at very low risk for ulceration annually for loss of protective sensation and peripheral artery disease and persons at higher risk at higher frequencies for additional risk factors. For preventing a foot ulcer, educate the at-risk patient about appropriate foot self-care and treat any pre-ulcerative sign on the foot. Instruct moderate-to-high risk patients to wear accommodative properly fitting therapeutic footwear, and consider instructing them to monitor foot skin temperature. Prescribe therapeutic footwear that has a demonstrated plantar pressure relieving effect during walking to prevent plantar foot ulcer recurrence. In patients that fail non-surgical treatment for an active or imminent ulcer, consider surgical intervention; we suggest not to use a nerve decompression procedure. Provide integrated foot care for high-risk patients to prevent ulcer recurrence. Following these recommendations will help health care professionals to provide better care for persons with diabetes at risk of foot ulceration, to increase the number of ulcer-free days, and to reduce the patient and health care burden of diabetic foot disease.
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Affiliation(s)
- Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde and CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
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van Netten JJ, Sacco ICN, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Bus SA. Treatment of modifiable risk factors for foot ulceration in persons with diabetes: a systematic review. Diabetes Metab Res Rev 2020; 36 Suppl 1:e3271. [PMID: 31957306 DOI: 10.1002/dmrr.3271] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/01/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prevention of diabetic foot ulcers is important. Preventative treatment mostly targets and aims to improve modifiable risk factors of foot ulceration. While effectiveness of interventions in ulcer prevention has been systematically reviewed, their effectiveness in improving modifiable risk factors is unknown. METHODS The available medical scientific literature in PubMed, Excerpta Medica Database, and the Cochrane database was searched for original research studies on six interventions to treat modifiable risk factors for diabetic foot ulceration (ie, education for patients; education for professionals; self-management; pre-ulcer treatment; orthotic interventions; and foot- and mobility-related exercises). We assessed interventions for eight outcomes (ie, patients' knowledge; treatment adherence; professionals' knowledge; pre-ulcers; mechanical stress; neuropathy symptoms; foot/ankle joint mobility; and foot function). Both controlled and noncontrolled studies were selected. Data from controlled studies were assessed for methodological quality by two independent reviewers and extracted and presented in evidence and risk of bias tables. RESULTS We included 72 publications (26 with a controlled study design and 46 noncontrolled). We found that structured education may improve foot self-care behaviour of patients, yearly foot examinations, and foot disease knowledge of health care professionals. Callus removal reduces peak plantar pressure. Custom-made therapeutic footwear can be effective in reducing plantar pressure and may reduce callus. Foot- and mobility-related exercises may improve neuropathy symptoms and foot and ankle joint range of motion, while they do not seem to reduce peak plantar pressure; evidence for their effect on foot strength is conflicting. CONCLUSIONS Structured education for patients and health care professionals, callus removal, custom-made therapeutic footwear, and foot- and mobility-related exercises may be beneficial for improving modifiable risk factors for foot ulceration. However, we generally found low quality of evidence for interventions targeting modifiable risk factors for ulceration in persons with diabetes, with frequently inconsistent or limited results available per intervention and outcome.
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Affiliation(s)
- Jaap J van Netten
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Diabetic Foot Clinic, Department of Surgery, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Isabel C N Sacco
- Physical Therapy, Speech, and Occupational Therapy Department, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matilde Monteiro-Soares
- MEDCIDES: Departamento de Medicina da Comunidade Informação e Decisão em Saúde & CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina da Universidade do Porto, Oporto, Portugal
| | | | - Anita Raspovic
- Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
| | - Sicco A Bus
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
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Reeve C, Johnston K, Young L. Health Profession Education in Remote or Geographically Isolated Settings: A Scoping Review. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520943595. [PMID: 32754648 PMCID: PMC7378721 DOI: 10.1177/2382120520943595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
Remote health has been differentiated from rural health in Australia and defined as isolated, with poor service access and a relatively high proportion of Indigenous residents, necessitating different models of care. Educational strategies for remote health practice are often needs driven and the characteristics of remote health may be used to categorise remote health professional education. This scoping review aims to identify the purpose of health professional education for remote settings, the type of educational strategies implemented and the reported outcomes. A broad search of published literature available in online bibliographic databases was conducted. A total of 33 articles met the review inclusion criteria. A further 7 articles were identified for inclusion in the review through citation searches and the authors' networks giving a total of 40 articles. Six primary themes were established based on the educational purpose: (1) cultural competency; (2) social accountability; (3) rural and remote skill development for the general workforce; (4) remote specialisation; (5) specialist skills required for a remote workforce; and (6) remote teaching. These themes also reflect the philosophical change over time recognising remote health as a separate discipline and its value as a distinctive and efficacious learning environment. The concept of education for remote practice is proposed to describe this unique leaning environment which encompasses critical pedagogy to develop a sense of agency and social accountability, embedding the delivery of primary health care through service learning and developing relationships in a context which is transformative.
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Affiliation(s)
- Carole Reeve
- James Cook University General Practice
Training, College of Medicine and Dentistry, Anton Breinl Research Centre for Health
Systems Strengthening, James Cook University, Townsville, QLD, Australia
| | - Karen Johnston
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
| | - Louise Young
- College of Medicine and Dentistry, Anton
Breinl Research Centre for Health Systems Strengthening, James Cook University,
Townsville, QLD, Australia
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Cabeceira HDS, de Souza DMST, Juliano Y, Veiga DF. Work ability and productivity in patients with diabetic foot. Clinics (Sao Paulo) 2019; 74:e421. [PMID: 30916210 PMCID: PMC6424068 DOI: 10.6061/clinics/2019/e421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 12/19/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess work ability and productivity in patients with diabetic foot. METHODS This investigation was a cross-sectional controlled study. A total of 117 individuals were selected from March to June 2014 and allocated to group A (patients without diabetes, n=43), group B (diabetes patients without foot ulcers, n=43), or group C (patients with diabetic foot, n=31). Two validated instruments, the Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire General Health v2.0 (WPAI-GH), were used to assess work ability and productivity. RESULTS The groups were homogeneous regarding age and sex; however, patients in group C had a lower education level than the other participants (p=0.006). The median WLQ scores for groups A, B, and C were 0.0121, 0.0146, and 0.0852, respectively (p<0.0001). The WPAI-GH scores revealed a mean productivity loss of 20% for groups A and B and 100% for group C (p<0.0001). CONCLUSIONS Patients with diabetic foot showed decreased work ability and productivity.
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Affiliation(s)
- Helga dos Santos Cabeceira
- Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
| | - Diba Maria Sebba Tosta de Souza
- Departamento de Enfermagem, Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
- *Corresponding author. E-mail:
| | - Yara Juliano
- Departamento de Bioestatistica, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
| | - Daniela Francescato Veiga
- Divisao de Cirurgia Plastica, Mestrado Profissional em Ciencias Aplicadas a Saude, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, MG, BR
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Demonstrating Impact: Lessons Learned from the Queensland Aboriginal and Islander Health Council's AOD-Our-Way Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030450. [PMID: 29510586 PMCID: PMC5876995 DOI: 10.3390/ijerph15030450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/04/2022]
Abstract
In this paper, we describe the innovative way in which the Queensland Aboriginal and Islander Health Council uses “clicker technology” to gather data to report on the key performance indicators of its “AOD-our-way” program, and how, with the subsequent combination of those data with other performance measures, it was possible to go beyond the initial evaluation. The paper also illustrates how the application of survey research methods could further enable enhanced reporting of program outcomes and impacts in an Indigenous context where Indigenous community controlled organisations want to build the evidence base for the issues they care about and ultimately drive their own research agendas.
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West M, Chuter V, Munteanu S, Hawke F. Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians. J Foot Ankle Res 2017; 10:48. [PMID: 29151893 PMCID: PMC5678749 DOI: 10.1186/s13047-017-0230-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians. METHODS MEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool. RESULTS Eleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications. CONCLUSIONS Aboriginal and Torres Strait Islander Australians have a 3-6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Fiona Hawke
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
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